This presentation provides information about ventilators including: - Definitions of key terms like tidal volume, PEEP, and pressure support. - The most common ventilator modes of Assist Control, SIMV, and Pressure Support and example settings. - Identifying patient data and settings on the two ventilators used - the Puritan Bennett 760 and Viasys LTV1200. - Common ventilator alarms like high pressure and disconnect and appropriate troubleshooting actions. - Other important aspects like using a clinometer to check head of bed elevation and maintaining heat and moisture with an HME.

1. Ventilator Education
Presentation by Rachelle Solum CRT 2014

2. Objectives: After this presentation you should be able to :
• Define key ventilator terms
• Understand 3 common vent modes and settings used on ventilators
• Identify the 2 vents we use, find patient data and setting data on them
• Identify 3 common vent alarms and be able to troubleshoot problems
and know what actions to take associated with those alarms
• Identify a clinometer and HME and their uses
• Identify LTV1200 exhalation port and sensors

3. DEFINITIONS
This section will define some commonly used terms
when discussing ventilators

4. Definitions
Tidal Volume
(Vt)
Rate/frequency
PEEP
FiO2
Pressure Support
 When the vent cycles it is set to give a
specific amount of Oxygen enriched air.
 If the vent has a set Tidal Volume (Vt) of
500ml, every breath given by the vent is
about 500ml.
 It sometimes is a little more or less
depending on how much effort there is
from the patient, pressure in the lungs and
other factors, but usually near 500ml.

5. Definitions
Tidal Volume (Vt)
Rate/frequency
PEEP
FiO2
Pressure Support
 How many breaths the patient
is breathing per minute based
on time between the beginning
of 2 breaths. This number can
change with every breath a
patient takes.

6. Definitions
Tidal Volume (Vt)
Rate/frequency
PEEP
FiO2
Pressure Support
 Positive End-Expiratory Pressure
 Air is pulled by the lungs into tiny
little air sacs called alveoli, which
are wet inside.
 Coughing, mucous production
and suctioning of the lungs can
collapse the alveoli and make
them resistant to re-opening.
 PEEP is a constant pressure inside
the patient's lungs that minimizes
the collapse of the alveoli and
helps recruit collapsed alveoli.

7. Definitions
Tidal Volume (Vt)
Rate/frequency
PEEP
FiO2
Pressure Support
 Fraction of Inspired Oxygen
 It's the oxygen setting on the
vent expressed as a percent.
 The range is 21% (room air) to
100%

8. Definitions
Tidal Volume (Vt)
Rate/frequency
PEEP
FiO2
Pressure
Support
 It is an extra push of pressure
to help with each breath.
 It increases the volume of
breath and works with PEEP
to increase the number of full
alveoli and helps patient get a
breath with less work.

9. Ventilator Modes and Settings
This section will explain the different vent modes and
settings we use most commonly

10. Ventilator Modes
 Assist Control (AC)
 Synchronized Intermittent
Mechanical Ventilation
(SIMV)
 Pressure Support (PS)
 These are the most
common vent modes
used
 The settings used in the
examples are not always
the numbers used.
 They are all tailored to
each patient depending
on their needs.

11. Assist Control (AC)
 This is the highest support available on the vent.
 Example: AC12, 500, 30%, +5 means that the rate is set
at 12, tidal volume (Vt) is set at 500, FiO2 is 30% and
PEEP is +5.
 The very least the patient gets is 12 full breaths per
minute with a Vt of 500ml.
 If the patient takes more than 12 breaths, the vent
senses their inspiratory effort and gives them the full
Vt of 500ml with each breath over 12.

12. Synchronized Intermittent
Mechanical Ventilation (SIMV)
 Example: SIMV12, 500, 30%, +5, +15 means that the rate is
set at 12, tidal volume (Vt) is set at 500, FiO2 is 30%, PEEP
is +5, and the pressure support (PS) is +15.
 Again, like AC, the very least the patient gets is 12 full
breaths per minute with a Vt of 500ml.
 If the patient takes more than 12 breaths, the vent senses
their inspiratory effort and gives them a breath with a PS of
+15 to help boost the volume. Those breaths are more work
and start to exercise the diaphragm and lungs.
 This is a mode that we use to start the weaning process.
Often we reduce the rate gradually (example: SIMV rate is
lowered 1 breath per day) to wean the patient.

13. Pressure Support (PS)
 Example: PS15, 30%, +5 means that pressure support is set
at +15, FiO2 is 30% and PEEP is +5.
 There is no set rate and no set tidal volume(Vt).
 ALL the patients breaths are at their own volume with a
pressure support behind them of +15.
 Pressure Support helps overcome the increased work of
breathing with an artificial airway and the resistance of the
vent circuit.
 This mode is usually used before trach mask trials begin.
 This is technically & sometimes referred to as CPAP mode.

14. Vent Changes
 ONLY a Respiratory Staff member is allowed to change ANY
ventilator settings on the vent.
 Parameters that we are NOT allowed to change without a Doctor’s
order:
• Mode(AC, SIMV, PS)
• Rate
• Tidal Volume (Vt)
• PEEP
• Pressure Support(PS)
 Our protocol allows us to titrate the FiO2 to maintain a Pulse Oximetry
(POX) level of 90% or above. This includes giving 100% O2 when
patient will be placed in a supine position, exerting effort or being
suctioned, when it is indicated.

15. Our Ventilators
This section will show you where to read the actual
patient data and where to read the vent settings on
each of the vents we are currently using

16. We have 2 ventilators
Puritan Bennett 760
(PB760)
Sometimes referred to as:
Big vent or old vent
Viasys LTV1200
(LTV1200)
Sometimes referred to as:
Small vent or new vent

17. Patient information
Where to see what the patient is actually doing on the vent
PB760 – RED circle is Pt info LTV1200 – RED circle is Pt info

18. Patient information
Where to see what the patient is actually doing on the vent
(Use THIS rate for actual patient respiratory rate)
PB760 LTV1200

19. Ventilator Settings
Where to find vent settings
PB760 LTV1200

20. Ventilator Settings
Where to Find the SettingsPB760
LTV1200 -
#’s are red
if active

21. 100% FiO2
How to give patient 100% FiO2 for suctioning or distress
PB760 LTV1200 bottom display

22. Alarms
This section will explain some common alarms, and how
YOU can troubleshoot ventilator alarms

23. Common Alarms
 High Pressure
 High Rate/Frequency
 Disconnect, Low Volume or Low Pressure

24. High Pressure
 Usually this alarm is activated when patient COUGHS
or NEEDS SUCTIONING.
 Action: Suction patient
 Sometimes activated when vent circuit is compressed.
 Action: Check vent circuit for kinks or compressions and
straighten out vent circuit.
 Lungs are not compliant with current vent
settings, patient “fighting” vent settings, or alarm set
to low.
 Action: Contact Respiratory Staff

25. High Rate/Frequency
 This alarm is activated when patient breathes more
times per minute than the alarm is set for, usually 40
breaths per minute. It may be due to anxiety, pain or
fatigue.
 Action: Contact Respiratory Staff, especially if patient is
weaning, diaphoretic or appears to be struggling with
breathing.
 Action: Check if patient needs anxiety or pain
medication.

26. Disconnect, Low Volume
or Low Pressure
 These alarms are usually activated when there is a
disconnection or leak somewhere in the vent circuit.
 Action: Check if patient is connected to vent at:
 Trach site
 Ballard & HME connection
 Filters connected to the vent
 Sometimes activated when patient is suctioned or if
the MDI or Saline port is open on the ballard.

27. Other Alarm Information
 There are many other alarms that may be activated. If
you can hear or see an alarm that you are unfamiliar
with, please contact Respiratory Staff.
 There is no need to worry if an alarm warning is on the
vent, but there is no audible alarm. The vents will
display the last alarm activated.
 Notify Respiratory Staff immediately after checking
patient if a vent is alarming in room, but no hallway
light or alarm is activated!

28. Additional Information
This section will provide some items you need to be
aware of when caring for our ventilated patients

29. Head Of Bed
ALWAYS make sure that ANY artificial airway
patient has their head elevated to 30 degrees
or greater. Please use the clinometers to
check the elevation.

30. HME – Heat Moisture Exchanger
 HME’s keeps heat and moisture in the air that the
patient breathes in. Because we do not use humidifiers
or heaters on our vents, these must be in place.
 Insure the HME is slightly elevated (an inch or two)
above the artificial airway so that it does not fill with
secretions.
 If you notice an HME filled with secretions or
moisture, please contact Respiratory Staff so that it
can be changed.

31. LTV1200
Exhalation port-
Make sure that this is not
covered or blocked, it is how
the CO2 leaves that patient
and exhaled Vt is measured.
Sensors-
These should be on the top of
the circuit so they are not
blocked with moisture. They
take measurements for vent
operation, such as pressure.

32. For more information
 Please ask any Respiratory Staff member